Credentialing Coordinator (RHIA, RHIT, or Nurse)

Location: Miami, FL
Date Posted: 09-25-2018
CareNational
Credentialing Coordinator (RHIA, RHIT, or Nurse) - Health Plan
Job Type:  Full Time, CONTRACT-TO-HIRE
Miami, FL (West Suburb, near Airport)
 

About the Job:
 
CareNational, a leading medical management recruitment and staffing organization, is currently looking for a Credentialing Coordinator for an expanding health plan in Miami, FL.
You will be responsible for initiating, processing, and completing the credentialing and credentialing functions for practitioners and providers. You will also be responsible for maintaining knowledge of NCQA and DPW regulations in order to maintain productivity and accuracy standards associated with the credentialing functions.
 
Credentialing Coordinator Job Summary:  
  • Process provider applications in an accurate (with 90% accuracy) timely manner within the 180-day verification time limit.
  • Review applications for completeness of the application and supporting credentials, including current status of all time-sensitive information.
  • Enter data of all initial credentialing and credentialing application into the credentialing database.
  • Request and obtain all missing information and/or updated information related to the application or source documents.
  • Establish a credentialing file for all new applicants.
  • Incorporate updated information and provider profile information in the credentialing file.
  • Perform primary source verification of all supporting provider credentials through telephone, fax, and online systems within the 180-day verification time limit.
  • Obtain primary source verification of licensure, education and training, and specialty board certification via telephone, fax, or online.
  • Query online databases for malpractice and sanction reports.
  • Communicate clearly and effectively when requesting verification of hospital privileges.
  • Obtain provider performance reports for the credentialing and credentialing process.
Credentialing Coordinator Background Profile:
 
  • Requires an education level of at least a Associates Degree, Bachelors degree preferred.
  • Requires experienced health professional, such as RHIA, RHIT, LPNs, or RNs
  • Requires at least 2-3 years of healthcare credentialing experience at a health plan or hospital.
  • Credentialing certification is highly preferred.
  • Strongly prefer prior healthcare database experience and experience working in hospital administration.
  • Basic familiarity with healthcare / medical industry is required.
  • Computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.

Credentialing Coordinator Benefits: 
 
Position provides a comprehensive benefits plans that include Medical, Dental, and Vision. Including 401(k), PTO, Paid Holidays, and Life Insurance benefits. 
 
We are an equal opportunity employer and value diversity in our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
 
 
#ADMIN or #CLINICAL
KAYLA ROGERS
ACCOUNT MANAGER
CareNational
kayla@carenational.com
623.201.8732 (CALL – TEXT – FAX)
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